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H, Anil; Patel, Shradha; Pujara, Reshma; Patel, Dipen; Nimbalkar, Somashekhar
doi: 10.1177/09732179231202184pmid: N/A
IntroductionNeonatal mortality is the major contributor for under five mortality. WHO and UNICEF have mentioned that it is vital to initiate breastfeeding within the first hour of birth for reducing mortality. In India, it has been reported that only 42.7% babies receive breastfeeding within 1 hour of birth, and at our institute, we noticed only 61% of stable babies delivered vaginally received breastfeeding within 1 hour of birth. So, we planned a quality improvement study at our hospital using POCQI (point of care quality improvement).Aims and ObjectivesTo increase the early initiation of breastfeeding (EIBF) practice in neonates born through vaginal delivery at or above 36 weeks of gestation from the observed baseline of 61% to >85% over 3 months period.MethodsThe study was conducted in Labor Room of a tertiary care hospital over a period of three months (Dec 2022–Feb 2023) and a sustenance phase from April 2023 to June 2023. A root-cause analysis was done using the fishbone framework focusing on various barriers related to mothers, hospital staff, policy, place, and practices. Based on this, a comprehensive early breastfeeding initiation intervention was planned utilizing Plan-Do-Study-Act (PDSA) cycles.ResultsAt the end of the 3 months, we were able to achieve 100% compliance in EIBF from baseline of 61% and same compliance was maintained during sustenance phase. Run charts used for interpretation showed increase in compliance and reduction in time of initiation of breastfeeding.ConclusionThis study brought out various hurdles to EIBF and demonstrated that it can be improved by using simple quality improvement model.
Singh, Srijan; Mane, Sushant; Singh, Srishti; Rai, Rohit
doi: 10.1177/09732179231204777pmid: N/A
IntroductionLactation education is an integral part of healthcare. In order to recognise and address the inconsistencies in perceptions, attitudes and delivery of lactation care, we developed the Lactation Aids and Milk Banking (LAMB) survey.AimThe purpose of the study was to compare the knowledge, attitude and practices of doctors and nurses about human milk banking and lactation aids and to examine institutional and individual barriers to and facilitators of the delivery of lactation care.MethodsIt was a cross-sectional study, and the survey questionnaire was administered electronically to neonatal physicians and nurses in a tertiary care hospital in India.ResultsThere were 86 participants, including 54 doctors (63%) and 32 (37%) nurses. There was no significant difference in the knowledge score of doctors and nurses (p = .61), although doctors scored significantly higher on the attitude and practices score as compared to nurses (p < .0001). Amongst the doctors, the knowledge score was higher for faculty than residents (p < .0001), though residents scored significantly higher on the attitude and practices score than faculty (p = .0002). This study highlighted five facilitators and two barriers to LAMB and also revealed that physicians and nurses have relatively inadequate knowledge about lactational aids and milk banking.ConclusionLactation education for staff can reinforce support for milk banking and lactation aids, thereby achieving the goal of exclusive breastfeeding. It is also important to mitigate barriers by establishing policies and guidelines in the unit for milk banking and the use of lactation aids.
Singh, Ishita; Chandran, Rabindran; B, Umamaheswari; Amboiram, Prakash
doi: 10.1177/09732179231211564pmid: N/A
BackgroundEarly Initiation of Breastfeeding (EIBF) reduces neonatal mortality up to three times, particularly in preterm and low-birth weight infants. Existing Lactation Support Program (LSP) of the institute tackles breastfeeding-related issues to achieve EIBF as early as possible for all delivered healthy infants. LSP was reformed by introducing new policy in February 2021 to achieve EIBF <1 hour in all healthy delivered neonates.AimThe aim of the study was to study the efficacy of new lactation policy of LSP on rates of EIBF and time to attain the first breastfeeding in late preterm neonates of gestational age 35+0 weeks -36+6 weeks.MethodA ‘before-and-after’ design was used to study the effect of the new policy on EIBF at a tertiary care institute in India from January 2018 to March 2023. Impact was assessed by comparing baseline data in pre-policy (group A) with that of new policy (group B).ResultAmong 417 babies included, 336 and 81 belonged to group A and B, respectively. EIBF rates were 42% and 99% in group A and group B, respectively (p < .0001). Median time to initiate EIBF was 100 min IQR [85–117] in group A compared to 26 minutes IQR [19–37] in group B (p < .0001).ConclusionLactation support program is an invaluable key practice for attainment of EIBF. Through simple measures, significant improvement in EIBF was possible in healthy late preterm population. This LSP can be considered as ideal model to be adapted at national level to improvise EIBF.
Minj, Grace Mary; Narayanaswamy, Vindhya; Nagesh, Karthik
doi: 10.1177/09732179231215889pmid: N/A
BackgroundThere is often a delay in the initiation of feeding in preterm babies and more dependence on PDHM milk due to the non-availability of the mother’s own milk. This study aimed to increase the percentage of very preterm neonates receiving expressed breast milk (EBM) within 24 hours of birth.MethodsA quality improvement (QI) initiative study was conducted from May 2022 to August 2022 in a tertiary care (Level III-B) NICU. A QI support team was formed. The reasons for the delay in the initiation of expression of breastmilk were evaluated. We included preterm neonates (<32 weeks gestation) born within the study period. Antenatal and postnatal counseling regarding the expression of breast milk, using leaflets and video, frequent visits, telephonic reminders, and emphasizing Kangaroo Mother Care through various Plan-Do-Study-Act cycles were done.ResultsA total of 17 very preterm babies were studied over a period of 3 months. The percentage of preterm receiving EBM within 24 hours of birth, increased from 20% (observation phase) to 83.3% (initiation phase) and maintained to 90% in the continuation phase. The time of receiving the first EBM reduced from a median of 32.5 hours (1.35 days) in the retrospective phase to 17 hours (0.7 days) during the initiation phase and it was sustained later on. Mothers were able to express as early as within 4.5 hours.ConclusionA simple QI intervention showed early expression and sustenance of breast milk in mothers of preterm neonates.
Wilson, Krishna N.; Rahul, Aswathy; Sujatha, Radhika; Amma, Sobhakumar Saraswathy; Sharma, Anu
doi: 10.1177/09732179231211464pmid: N/A
BackgroundThough early enteral nutrition with Mother’s own milk (MOM) is the norm in preterms, it is a difficult challenge to get it into the intensive care unit due to various medical and logistic issues. Awareness about this among pregnant ladies and their caregivers from the antenatal period may help to overcome some of these difficulties.ObjectiveTo compare the effect of the implementation of an antenatal breast milk care bundle on the availability of adequate breast milk on day 7 for preterm babies ≤ 32 weeks when compared to a postnatal breast milk care bundle alone.MethodologyThis prospective study was conducted among neonates ≤32 weeks born in Government Medical College, Thiruvananthapuram from January 2021 to May 2022. Antenatal bundles were implemented in the antenatal OPDs and wards. Postnatal bundles were implemented in the NICU and postnatal wards. The outcome was compared among babies of mothers who got both the care bundles and those who received only the postnatal care bundle.ResultsA total of 110 babies were included in the study. There was a 1.32 times increase in the adequacy of milk volume on day 7 (CI: 1.04–1.68), a significant increase in the proportion of mothers expressing within 24 hours, and babies getting discharged on exclusive MOM in those who received the antenatal BMC bundles. The risk for inadequate milk volume was high in those who have <2 ml of milk at 48 hours (RR: 1.67, CI:1.26–2.20].ConclusionAntenatal breast milk care bundles can increase the availability of adequate MOM for preterm babies.
Shadab, Shazia; Kumar, R. Kishore; Kini, Prakash; Patterson, Ruth; Managoli, Surekha Sanjeev; Sachin, Namitha
doi: 10.1177/09732179231221041pmid: N/A
BackgroundBreastfeeding is crucial for maternal and child health. However, mastitis and lactational breast abscesses (LBAs), pose serious health risks for nursing mothers and are traditionally treated with minor surgery, that often separates mother and child, and causes significant maternal distress. This study investigates dynamic tape (DT) as a nonsurgical intervention for LBAs that will allow breastfeeding even during treatment in postpartum Indian women.MethodsThis prospective, observational cohort study was conducted at a tertiary maternity center (Karnataka, India) between October 2017 and December 2018 [CTRI Number/2018/05/013788]. Twenty postpartum women with mastitis and LBA were subjected to dynamic taping (using DT Beige Tattoo or DT Eco based on breast size and abscess location). LBA resolution was confirmed through ultrasonography and clinical examination.ResultsTwenty participants (median age = 30 years) completed the study without adverse reactions; 65% practiced exclusive breastfeeding. Lump sizes and pus volumes were significantly reduced after treatment; 60% experienced self-drainage, 35% experienced resolution without self-drainage, and only 5% did not experience resolution; average time to resolution was 13.95 days, with each taping session lasting 3.85 days. The mean lump measurement and pus volume significantly reduced post-treatment from 108.7 cm3 and 54.58 ml to 3.14 cm3 and 1.07 ml, respectively, with 95% experiencing abscess resolution. The positive outcomes were observed during the three-month follow-up, with no recurrence of LBAs.ConclusionsDynamic taping resolves LBAs without surgery, by aiding lymphatic flow, reducing inflammation, and supporting breastfeeding. Larger randomized studies are required to validate its efficacy and safety.
Goyal, Kavya; Arya, Sugandha; Guliani, BP
doi: 10.1177/09732179231220208pmid: N/A
IntroductionHuman milk has many antioxidants like Docosahexaenoic acid (DHA), inositol, and vitamin E that combat oxidative stress deregulating VEGF which is implicated in the pathogenesis of retinopathy of prematurity (ROP). Thus, it is biologically plausible that human milk is protective towards ROP.Aim and objectiveThe study aimed to find the association between ROP and breast milk feeding.MethodologyThe prospective cohort study was carried out for 18 months at the Newborn unit, SJH. In our study, mothers were asked to maintain a feeding diary (type of milk fed) and history was taken from the mother regularly. Each neonate was later assigned a feeding category including exclusively breast milk fed, more than 50% breast milk fed, more than 50% top milk-fed, and exclusively top milk fed. At four weeks of age, all these neonates were called to undergo screening for ROP. In the case of immature retina, neonates were followed up for repeat fundus exams and results were included in the study.ResultA study on 521 neonates between birth weight of 1–1.8 kgs found that predominant breast milk feeding reduces the chance of any stage ROP (needing repeat screening or intervention). The total incidence of any stage ROP in this study was noted to be 16.2% where 4.1% of total neonates from the predominantly breastfed group as compared to 37.8% from the predominantly top-fed group developed any stage ROP.ConclusionBreast milk feeding has a significant benefit in reducing any stage ROP and ROP needing intervention, thus it has the potential to prevent a significant cause of childhood blindness.What is already known– Breast milk feeding may be protective towards ROPWhat the study adds– Breast milk feeding is independently protective towards ROP
Gedam, D Sharad; Prajapati, Rajanya; Verma, Mamta
doi: 10.1177/09732179231220200pmid: N/A
ObjectiveTo improve the rate of first-hour breastfeeding in term and near-term healthy neonates by a quality improvement (QI) study at Secondary Care District Hospital.DesignQI study.SettingLabor room-operation theatre of a secondary care district hospital.ParticipantsStable newborns ≥35 weeks of gestation born by normal vaginal delivery and by cesarean section under spinal anesthesia.ProcedureA team of nurses, pediatricians, obstetricians, and anesthetists analyzed possible reasons for delayed initiation of breastfeeding by flow chart and Fishbone analysis. Various change ideas were tested through sequential Plan-Do-Study-Act cycles.Outcome measureProportion of eligible babies breastfed within 1 hour of delivery.ResultsThe rate of first-hour initiation of breastfeeding increased from 69% to 88% in normal vaginal deliveries and from 17% to 61% in the cesarian section over the study period, which were sustained up to 80% in normal vaginal deliveries (NVD) and 55% in lower segment cesarean section.ConclusionsA QI approach was able to accomplish sustained improvement in first-hour breastfeeding rates in normal and cesarean deliveries.
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